Allogenic hematopoietic stem cell transplantation is feasible in pediatric patients with an active or recently diagnosed invasive fungal infection

Transplant Cell Ther. 2021 Jun 18:S2666-6367(21)00999-4. doi: 10.1016/j.jtct.2021.06.015. Online ahead of print.


BACKGROUND: Data on the outcome of allogenic hematopoietic stem cell transplantation (HSCT) in pediatric patients with a history of invasive fungal infection (IFI) is limited.

OBJECTIVE: The aim of this study was to report on the feasibility and outcome of allogenic HSCT in pediatric patients with an active or recently diagnosed IFI.

STUDY DESIGN: In this retrospective single center study 317 children underwent an allogenic HSCT (January 2012 – June 2020), of which 23 patients had an active or recent (<six months before transplantation) diagnosis of a probable or proven IFI before HSCT. Medical records were reviewed for data collection. Descriptive statistics were performed. One-year survival was described with the Kaplan Meier analysis.

RESULTS: Four proven and 19 probable IFIs were diagnosed. The lungs were the main site of infection (22 out of 23 patients), brain involvement was diagnosed in six (26.1%). Aspergillus species (spp.) was the most frequently identified organism. Four patients were diagnosed with mucormycosis of which three were mixed infections with Aspergillus spp. One patient was diagnosed with an Alternaria sinusitis and one patient with an infection with Curvularia spp. with both pulmonary and cutaneous involvement. One year after HSCT 18 of the 23 patients (78,3%) were alive. Four of the five patients that did not survive, died of non-IFI related causes. One patient died to a newly developed IFI post-transplant. Three patients showed non-fatal progression of their original IFI that required prolonged antifungal treatment.

CONCLUSIONS: Survival of this cohort of high risk pediatric patients who underwent allogenic HSCT with an active or recently diagnosed IFI was favorable. An active IFI or recent history of IFI should not be a contra-indication for proceeding to allogenic HSCT.

PMID:34153502 | DOI:10.1016/j.jtct.2021.06.015

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